PB2445: THE ROLE OF MEDITERRANEAN DIET IN CHRONIC GVHD: A PILOT STUDY
Authors: Giulia Brambilla, Enrico Morello, Mirko Farina, Francesco Arena, Emanuela Samarani, Marco Andreoli, Michele Malagola, Domenico Russo
Journal: HemaSphere (2023)

Topic: 22. Stem cell transplantation - Clinical Background: The role of nutrition in the pathogenesis and management of chronic GVHD is poorly investigated. Diet influence on inflammatory chronic disease is reported in several settings and the Mediterranean diet seems to be one of the most anti-inflammatory diets. Predimed questionnaire was developed to define adherence to Mediterranean diet and many reports validate it in the setting of several diseases including autoimmune ones. The questionnaire includes 14 questions, and each question worth 1 point. The final score ranges from a minimum of 0 to 14. The higher the score is and the higher the adherence is. The score range is divided into three levels of adherence. A score ranging from 0 to 5 means low adherence, a score from 6 to 9 means mild adherence and a score between 10 and 14 means good adherence. Aims: To explore the role of mediterranean diet in allogeneic transplanted patients, during their long term follow-up Methods: In this report adherence to Mediterranean diet was analyzed in a cross sectional study. The predimed questionnaire was submitted to 127 patients attending the long term follow-up clinic at the University Hospital in Brescia - Italy. Seventy-one patients were analyzed to identify adherence to Mediterranean diet and its correlation with clinical outcome, in particular chronic GVHD. Together with the questionnaire two more questions were administered: if the patient is on a gluten- or a lactose-free or reduced diet after HSCT. Furthermore patients requiring a nutritional intervention were analyzed according to the predimed questionnaire, cGVHD and Body Weight. Results: Seventy-one patients (56%) responded to the questionnaire and were analyzed. Patients’ characteristics are reported in table 1. Mean BMI of the selected population is 24.4 kg/sqm, 4% underweight, 37% normal weight, 51% overweight and 6% obese. Chronic GVHD is absent in the majority of cases (58%, 41 patients), 16 patients (23%), 9 (12%) and 5 (7%) present mild, moderate and severe cGVHD, respectively. Adherence to the Mediterranean diet was high in 13 patients, moderate in 48 and low in 10 patients. According to cGVHD expression, low adherence was found in 12.3% of patients with absent or mild cGVHD and in 21.4% of patients with moderate-severe GVHD (not significant). Comparable proportions were found in patients with moderate adherence (68.4 vs 64.3%, respectively), instead 19.3% of patients with absent/mild cGVHD reported a good adherence in comparison to 14.3% to those with moderate-severe cGVHD. Gluten free/reduced diet was reported by 18 patients, and lactose free/reduced diet by 29 patients. Patients with reduced gluten consumption had higher severity of cGVHD (7/18 vs 7/53, p=0.01798), probably because of an attempt to reduce severity of symptoms, caused also by known gluten inflammatory characteristics. Eleven patients with metabolic syndrome and obesity require nutritional intervention and were proposed to follow a poor-gluten/lactose mediterranean diet according to taste preferences and followed by the BMT Unit dietitian. All the patients had a sustained weight reduction after a median follow-up of 6 months (81.6 kg before intervention and 74.2 Kg after intervention, p=0.001 Anova test). Patients with GVHD experienced an improvement of symptoms and mean degree of GVHD improved from moderate to mild (p=0.016 Anova test). Summary/Conclusion: Despite the low number of interviewed patients and the little sample of nutritional intervention, to our knowledge this is the first report exploring the role of the Mediterranean diet in the setting of chronic GVHD. These results should be further explored to better integrate nutritional support and Mediterranean diet in the clinical practice. Keywords: Graft-versus-host disease (GVHD), Supportive care, Allogeneic hematopoietic stem cell transplant